Initial Session Standards of Care

The following are standards of care for Nourish dietitians in initial sessions. Care should follow the ADIME standard — Assessment, Diagnosis, Intervention, and Monitoring / Evaluation.

Think of these expectations as guidelines rather than a comprehensive script or checklist — dietitians should develop their own style, maintain flexibility, and tailor their approach to the patient and the agenda that feels right in each session.

Welcome the patient and introduce yourself. It’s important to build rapport with the patient — tell them about yourself and get to know them.

• 💡 Tips

  • Building a connection on a personal level with the patient is a critical part of high-quality care — ask them to tell you about themselves and work hard to connect where possible on topics like location, weather, or hobbies. Share topics from your personal life where you’re comfortable.

  • Building trust and rapport is essential for creating long-term, sustainable behavior changes with your patients. This is a key part of the initial session — more important than getting through 100% of your assessment.

  • Share about your background (education, credentials), location, and how long you’ve been an RD. Share any expertise you have that is relevant to them.

  • “Why are you here today?” and “Have you met with a dietitian before?” are great questions to ask early in the conversation. Getting to the crux of why a patient is meeting with an RD and unearthing any preconceived notions they may have is a great way to build rapport early on.

Set expectations by outlining an agenda for the initial session. Educate the patient on what a dietitian is and Nourish's Clinical Philosophy.

• 💡 Tips

  • It can be helpful to give an overview of what Nourish is and how working with a dietitian can give more personalized solutions and support vs. other options (such as traditional diet plans or standalone apps). This is especially valuable if the patient has not worked with a dietitian before.

  • Be sure to establish yourself as the medical professional. It is important in the initial session to communicate confidently and to drive the session. You, of course, want to meet the patient where they are, but you cannot lean on the patient to run the session — that is your job.

• 🔊 Examples

  • “In this first session, I will conduct a Comprehensive Nutrition Assessment. I will ask a lot of questions today to gather a full understanding of your lifestyle habits and medical/nutrition history, assess how you’re feeling and your nutrition needs, so that by the end of session we can begin to develop an individualized plan to help you reach your health goals. We will also set short and long-term goals based on that assessment. How does that sound to you?”

  • “What makes the Nourish program effective is that we focus on a long-term, sustainable approach, with a Registered Dietitian supporting you the whole way. We work together on true behavior and lifestyle change. We will never put you on a fad diet that is impossible to maintain, or give you some generic, one-size-fits-all meal plan. We give you the tools you need for long-term success - educating you on the ‘why’ and ‘how’ of food rather than just telling you what to do. And then we’re there every step along the way to support you through change, guiding you and problem solving together.”

Confirm the Release of Information form is complete and accurate. Inform your patient that to provide them with the best overall care, Nourish will share notes with any existing healthcare providers they work with. Ask if they are comfortable with that.

• 🔊 Examples

  • “I would like to confirm that Dr. XYZ is your primary MD. At Nourish, we believe in collaborating with all of your healthcare providers. This is because you and I will be seeing each other more frequently than your doctor, and I want to keep them informed of your health progress and any nutritional changes. By doing so, they will be able to provide you with the best care possible when you see them again.”

Gather relevant information including baseline health metrics as laid out in the chart note. Where relevant, explain the “Why” behind what you’re asking so that the patient is invested.

• 💡 Tips

  • Asking a patient to walk you through a typical day is a great way to gather the relevant information in the chart note template. Let them guide you through their intake instead of using the same question-by-question structure within the chart note each time.

  • Be sure to maintain a conversational tone to build rapport with the patient — no one likes to feel like they’re being asked a list of questions. Focus on the patient rather than solely relying on chart notes. Make sure to understand the patient’s unique situation.

  • Use motivational interviewing to encourage active participation from the patient, and tailor it to what’s most important to them. Don’t stop at what the patient first says — stay curious and ask for specifics to better understand! Avoid making assumptions.

  • It’s okay if you don’t get to everything in the first session! You can always address things in follow-up sessions — just note “to discuss at future session” in the chart.

  • Use your clinical judgment on which outcomes to collect during the session. If there’s something that does not make sense to collect in the initial appointment, come back to it. You do not need to ask every outcome question to every patient.

    • Ensure patients are aware of the reason we collect patient outcomes, especially the important role outcome play in measuring patient progress.

• 🔊 Examples

  • “Let’s begin with your nutrition assessment. I’m going to gather a full understanding of your habits and medical history to help me develop a care plan. Can you walk me through a typical day of yours? Please include when you wake up, what you eat, and what you do. This will help me identify patterns and determine the best plan of care for you. Please try to give me as accurate a picture as possible — there won’t be any judgment from me!”

  • “I just need to ask you a few more detailed questions to make sure I am getting all the information I need here, so bare with me.”

  • “Our mission at Nourish is to help you achieve your health goals by making it easy to eat well. To better understand the progress you’re making towards these health goals, and to visualize that progress to you, Nourish is asking you to complete a monthly progress check-in, starting with a baseline we’ll collect today. Providing an update is optional! However, this information will help your dietitian and Nourish understand your progress and take the right steps towards helping you get to where you want to be on your health journey.”

Give the patient an overview of your assessment and provide any initial education / intervention. Communicate your treatment plan to the patient including short / long-term goals, your initial recommendations, and how you’ll track progress toward goals.

• 💡 Tips

  • It’s okay not to have a “perfect” plan after the first session — you will gather more information as you work with the patient and can refine your assessment / interventions based on what you learn.

  • Some example parts of a plan that can be effective:

    • Repair (correct any imbalances or deficiencies)

    • Adequacy (ensure the body is being fueled adequately)

    • Balance (ensure a balance of nutrient timing as well as macros)

    • Variety (incorporate food variety to provide all necessary micronutrients)

    • Foods (fine-tune food choices to meet patients goals and preferences)

  • Educating the patient is crucial — be sure to discuss nutrition problems and causes / contributing factors that you have identified and how those are informing the plan of care. Be sure to spend time on the “Why” to help the patient understand the purpose of what you’re saying.

    • But, don’t overeducate the patient in the first session — it can be overwhelming and your interventions won’t stick. Instead, spread out education and intervention over many sessions. Try to provide different pieces of knowledge throughout the session, not just at the end.

  • Spend time discussing how you’ll track progress — this could be lab work, leveraging the Nourish app, or third-party apps, as relevant.

• 🔊 Examples

  • “Thank you for answering all those questions — it is really helpful for me so that I can develop the most effective plan for you and your needs. Now, I’ll spend time talking through my initial assessment and what we can do together to help you hit your goals. How does that sound?”

  • “Based on my initial assessment, it's clear why you have been struggling with XYZ. I have an idea why all your past attempts have not been successful. I know how to help you, and in future sessions we will dig further into the root cause.”

  • “To achieve your goals, I recommend starting with XYZ because it lays the foundation for your long-term objectives.”

  • “I understand your desire to jump straight into achieving your goal of XYZ. However, previous attempts have taken this approach, and you have not seen long-term success. To ensure that you never have to diet again, we will do things differently by first starting with the repair phase of your plan of care for your body.”

  • “Based on my nutrition assessment, I can see why your past attempts at weight loss have ended with regaining the weight. I can see what has been missing in your past attempts and how you and I can make a long-term impact. There are a few things that your past attempts have missed, which have led to this cycle of weight gain and loss. We need to address those before jumping into weight loss, or else you will end up in the same frustrating cycle again. I’d like to start with a repair phase, which will involve correcting any imbalances and deficiencies in your diet.”

Set action items to help them improve until the next session. Make sure they don’t leave the first session without next steps. Let them know that they can expect a follow up email summarizing key points of the appointment, including any action items, recommendations, and resources.

• 💡 Tips

  • Set 2-3 SMART Goals. Make sure each goal ties back to the patient’s overall reason for visit and explain how smaller goals tie into the treatment plan.

    • For example, instead of “eat breakfast”, try “eat breakfast three times this week; choose from the list of breakfast options we discussed.” Instead of “drink more water”, try “keep a water bottle at your desk while working, and drink four bottles per day. While driving to and from work, try to drink at least one water bottle.”

  • Get the patient’s feedback on each goal and collaborate on the goal together. For example, “How would you feel about eating breakfast three times this week from the options we discussed?” The patient is more likely to achieve a goal if they are a part of making the goal.

  • Tell patients that they can access their old appointment summaries in the Nourish app or web portal.

  • Be sure to assess barriers to goals and their confidence around goals. For example, “On a scale from 1-10 how likely do you feel you can meet this goal?” or “Can you anticipate anything that may be a barrier to this goal?”

Give an overview of the Nourish Program and set expectations for how you’ll work together moving forward. Encourage them to use the Nourish app or web portal.

• 💡 Tips

  • Ask how the appointment was and if it met their expectations. Asking “What did you think of the session today?” and “Does that sound like an accurate assessment?” are good ways to check how things are going. You can then adjust the care plan based on the patient input.

  • This section is one of the most important parts of getting them to buy in to future sessions. Getting feedback on the session is a valuable way of meeting the patient where they are and ensuring that RD interventions developed and shared align with the the patient’s goals. Explain that you are going to be there to support them every step of the way, and are eager to continue on their journey with them.

  • Ask if weekly sessions sound good to the patient after you explain the program. If they balk at the idea, reiterate the importance of weekly, and then offer biweekly if you do not feel weekly will be possible or well-suited for them.

• 🔊 Examples

  • “The Nourish program typically begins with weekly 55-minute sessions. Based on everything we’ve discussed today and your goals, I would like to see you on a weekly basis to start. In follow-up sessions, we will work together to fine-tune and implement the care plan we just discussed. I will keep providing recommendations and resources and we will monitor progress toward your goals and set new goals. Over time, session frequency can be reduced depending on progress. The total length of the program varies depending on the progress we make, but we typically see the best results after at least 12 sessions. Throughout the program, you will have access to the Nourish app on your phone, which will help us work together to track and hit your health goals. How does that sound to you?”

Schedule follow-up sessions and add the appointment to the calendar. Determine mutual availability and suggest booking weekly recurring appointments for at least the length of the Nourish program. Remind the patient of the no-show / cancellation policy. Explain that recurring sessions can be adjusted as needed in the app / portal.

• 💡 Tips

  • Try to book a minimum of 8 recurring appointments to ensure that you have the patient on your calendar consistently for the future and do not have any issues with future availability / appointment requests from a Nourish booking perspective.

  • Getting verbal consent of the patient's understanding of the no-show / cancellation policy is a good way to reduce no shows and is better for rapport if a patient does late cancel / no show and gets charged a fee.

• 🔊 Examples

  • “Based on my experience, working with a patient weekly tends to result in more efficient goal achievement. Let's schedule weekly appointments to ensure you meet your goals in a timely manner.”

  • “Normally patients start off meeting weekly to get get a kick start toward their goals. How does that work for you?” (Still gives the patient autonomy but normalizes weekly appointments)

  • “Does this time work for you weekly? I’d love to get a recurring appointment on the books to make sure your time slot isn’t taken.”